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The aim was to evaluate short- and long-term outcomes in patients with high hip dislocation operated with subtrochanteric shortening osteotomy and uncemented total hip arthroplasty.

This study examines the accuracy of digital templating in uncemented total hip arthroplasty (THA), i.e., whether the templated components where actually inserted during surgery. The surgical outcome was evaluated on the basis of limb length equality.

BackgroundLabral repair and biceps tenodesis are routine operations for superior labrum anterior posterior (SLAP) lesion of the shoulder, but evidence of their efficacy is lacking. We evaluated the effect of labral repair, biceps tenodesis and sham surgery on SLAP lesions.MethodsA double-blind, sham-controlled trial was conducted with 118 surgical candidates (mean age 40 years), with patient history, clinical symptoms and MRI arthrography indicating an isolated type II SLAP lesion. Patients were randomly assigned to either labral repair (n=40), biceps tenodesis (n=39) or sham surgery (n=39) if arthroscopy revealed an isolated SLAP II lesion. Primary outcomes at 6 and 24 months were clinical Rowe score ranging from 0 to 100 (best possible) and Western Ontario Shoulder Instability Index (WOSI) ranging from 0 (best possible) to 2100. Secondary outcomes were Oxford Instability Shoulder Score, change in main symptoms, EuroQol (EQ-5D and EQ-VAS), patient satisfaction and complications.ResultsThere were no significant between-group differences at any follow-up in any outcome. Between-group differences in Rowe scores at 2 years were: biceps tenodesis versus labral repair: 1.0 (95% CI −5.4 to 7.4), p=0.76; biceps tenodesis versus sham surgery: 1.6 (95% CI −5.0 to 8.1), p=0.64; and labral repair versus sham surgery: 0.6 (95% CI −5.9 to 7.0), p=0.86. Similar results—no differences between groups—were found for WOSI scores. Postoperative stiffness occurred in five patients after labral repair and in four patients after tenodesis.ConclusionNeither labral repair nor biceps tenodesis had any significant clinical benefit over sham surgery for patients with SLAP II lesions in the population studied.Trial registration numberClinicalTrials.gov identifier: NCT00586742

Introduction Bone cement for fixation of prostheses, comorbidity and age have been previously shown to be associated with increased relative risk of mortality within the first day of surgery. However, the proportion of mortalities associated to each of these exposures is not adequately expressed by relative risk estimates.Materials and methods The attributable fraction (AF), i.e. the fraction of diseased individuals attributed to a given risk factor, was estimated for cemented fixation of hip prostheses in the elderly (>65 years) with a hip fracture. Dementia, symptomatic comorbidity (American Society of Anesthesiologists (ASA)≥ 3), old age (≥85 years), male gender, and a delay of 24 hours or more from fracture to operation were considered as additional risk factors for a fatal outcome in close proximity to surgery.Results In the entire study population (n = 11210), the unadjusted and adjusted population AFs of cemented fixation on mortalities within the first day after surgery were 0.58 (95% CI 0.28-0.76) and 0.59 (95% CI 0.29-0.76), respectively. Symptomatic comorbidity and old age as risk factors had population AFs of 0.71 (95% CI 0.51-0.83) and 0.55 (95% CI 0.39-0.67), respectively. Male gender, dementia and time from fracture to operation all had considerably lower population AFs.Conclusions The estimated AFs on perioperative mortality in hip fracture patients treated by hemiarthroplasty showed that about half of the mortalities within the first day of surgery could be associated with the use of bone cement.

OBJECTIVES: The overall aim of this study was to evaluate the acetabular coverage of the femoral head as measured by the centre-edge (CE) angle of Wiberg and to evaluate any association between low back pain and hip dysplasia in a Sami-dominated area (the municipalities of Karasjok and Kautokeino) in north Norway.STUDY DESIGN: A cross-sectional population-based study, which included questionnaires and a radiographic examination of the hips.METHODS:A total of 1723 individuals were invited to participate in a general health survey. Of these, 78.2% attended the screening and filled out a questionnaire that included questions about ethnicity and symptoms of back problems; 836 participants returned the questionnaire. Back problems were reported by 210 participants, the rest had no complaints. All 210 participants with back problems and a random sample of 206 with no back pain were invited for a radiographic examination, 75% and 76%, respectively, showed up for the examination.RESULTS:The centre-edge (CE) angle of Wiberg was found to be 28 (+/-7) and 27 (+/-7) degrees for the left and right hip, respectively. Our results showed that 17% of the Sami had definite dysplasia, 21% had light dysplasia and 62% had normal hip joints. Thus, 38% of the Sami had more or less dysplastic hips. The oldest participants had a significantly smaller CE-angle than the younger ones. However, no associations were found between acetabular dysplasia and back complaints.CONCLUSIONS:A high prevalence of hip dysplasia was found in this Sami-dominant area. No significant association could be found between low back pain and dysplasia.

In this study, physical and mental health were investigated in 30 young adults who were operated on for idiopathic scoliosis, 2–3 years after surgery, and the results compared to an age- and sex-matched control group of 40 individuals. We used the short form of the 36 health survey (SF-36 version 1.2), which is a 36-item questionnaire measuring health functioning on eight scales: physical functioning, role limitations due to physical functioning, bodily pain, general health perceptions, vitality, social functioning, emotional role limitation, and general mental health. The patient scores indicated lower than the controls in physical health but higher in mental health. Otherwise, there were no significant differences between the two groups. Overall, this study showed that young adults operated on for idiopathic scoliosis were satisfied, and that their mental health was even better than the normal group, but their physical health was somewhat poorer. Thus, the surgical procedure was well tolerated and had not traumatized the patient.

In this study, physical and mental health were investigated in 30 young adults who were operated on for idiopathic scoliosis, 2–3 years after surgery, and the results compared to an age- and sex-matched control group of 40 individuals. We used the short form of the 36 health survey (SF-36 version 1.2), which is a 36-item questionnaire measuring health functioning on eight scales: physical functioning, role limitations due to physical functioning, bodily pain, general health perceptions, vitality, social functioning, emotional role limitation, and general mental health. The patient scores indicated lower than the controls in physical health but higher in mental health. Otherwise, there were no significant differences between the two groups. Overall, this study showed that young adults operated on for idiopathic scoliosis were satisfied, and that their mental health was even better than the normal group, but their physical health was somewhat poorer. Thus, the surgical procedure was well tolerated and had not traumatized the patient.

The treatment of tibial fractures associated with severe soft tissue injury remains a challenge. The objective of our experiment was to ascertain the influence of standardized muscle injuries on fracture healing in a nailed rat tibial fracture model. We hypothesized that a severe crush injury of leg muscles might not be as deleterious to fracture healing as total loss of a large muscle segment.

In this experimental study, the influence of flexible nailing in the later phase of femoral fracture healing was investigated. Sixty rats were randomly assigned to three groups. In 20 rats no intervention was performed, and they served as a control group. Fracture and reamed nailing with a rigid steel nail was performed in the left femur in the other 40 rats. These rats were reoperated after 30 days, and the medullary nail was removed. In one group (20 rats) a flexible polyethylene nail was installed (flexibly nailed group), while the rats in the other group received a steel nail identical to the one that was removed (rigidly nailed group). At 60 and 90 days, the left femurs of 10 animals in each group were studied clinically, radiologically, and biomechanically, and bone mineralization was measured by dual-energy X-ray absorptiometry. Radiographs in two planes revealed a clearly visible fracture line in both intervention groups at 60 days. At 90 days, the fracture line was clearly visible in the flexibly nailed group, while bridging callus was apparent after the rigid nailing. At 60 and 90 days, the callus area in the flexibly nailed group was significantly larger than that in the rigidly nailed bones. Biomechanically, flexible nailing reduced maximum bending load and fracture energy at 60 and 90 days compared with findings in rigidly nailed bones, while bending rigidity was similar in the two groups. All values for biomechanical characteristics were reduced at 60 and 90 days in flexibly nailed bones compared with intact femurs, while in the rigid nailing group, bending load and fracture energy were similar to those in intact bones at 90 days. Bone mineral content in the callus segment and diaphysis was greater in the rigidly nailed bones than in the flexible nailing group at 60 days, while at 90 days, no differences were detected. In conclusion, this animal study indicates that: (1) flexible nailing in the later phase of fracture healing increases callus formation, while (2) the quality of bone healing is reduced.

Abstract.: In this experimental study, the influence of flex-ible nailing in the later phase of femoral fracture healing was investigated. Sixty rats were randomly assigned to three groups. In 20 rats no intervention was performed, and they served as a control group. Fracture and reamed nailing with a rigid steel nail was performed in the left femur in the other 40 rats. These rats were reoperated after 30 days, and the medullary nail was removed. In one group (20 rats) a flexible polyethylene nail was installed (flexibly nailed group), while the rats in the other group received a steel nail identical to the one that was removed (rigidly nailed group). At 60 and 90 days, the left femurs of 10 animals in each group were studied clinically, radiologically, and biomechanically, and bone mineralization was measured by dual-energy X-ray absorptiometry. Radiographs in two planes revealed a clearly visible fracture line in both intervention groups at 60 days. At 90 days, the fracture line was clearly visible in the flexibly nailed group, while bridging callus was apparent after the rigid nailing. At 60 and 90 days, the callus area in the flexibly nailed group was significantly larger than that in the rigidly nailed bones. Biomechanically, flexible nailing reduced maximum bending load and fracture energy at 60 and 90 days compared with findings in rigidly nailed bones, while bending rigidity was similar in the two groups. All values for biomechanical characteristics were reduced at 60 and 90 days in flexibly nailed bones compared with intact femurs, while in the rigid nailing group, bending load and fracture energy were similar to those in intact bones at 90 days. Bone mineral content in the callus segment and diaphysis was greater in the rigidly nailed bones than in the flexible nailing group at 60 days, while at 90 days, no differences were detected. In conclusion, this animal study indicates that: (1) flexible nailing in the later phase of fracture healing increases callus formation, while (2) the quality of bone healing is reduced.

Abstract.: Objective:: Pathological rotation of the leg is a well-known problem in paediatric orthopaedics. In this study the normal development of tibial torsion during growth was evaluated by computed tomography (CT). Design:: Seventy-eight normal individuals (52 children, 26 adults) aged 3–51 years were examined with CT. In axial scans the angle between a line tangential to the posterior part of the femoral condyles and the intermalleolar line, a line through the centre of the lateral and medial malleolus, was measured. The radiation exposure was evaluated and accepted by The National Department for Radiation and the Regional Committee for Ethics in Science. Results:: CT showed that the average lateral torsion of the leg at the age of 4 years was 28° with an individual variation of 20°–37°. Later the increase in tibial torsion was on average 1°/year until 10 years of age and, thereafter, 4° until maturity when the mean lateral torsion was 38° (18°–47°). Conclusion:: Tibial torsion in children mainly develops during the first 4 years of life. After this the increase was of less clinical significance.

The present study demonstrates that high‐resolution radiostereometric analysis (RSA) can be used to assess global longitudinal compressive deformation across the callotasis zone during loading. In an achondroplastic patient operated with bifocal lengthening of the tibia by use of the Ilizarov external fixator, the axial compressive intersegmental strain in the proximal lengthening zone under a load of 71% of body weight was 7.7 mm. The proximal lengthening zone was 51.0 mm, and accordingly the overall linear strain across the callotasis was 15.1%. This large strain value found in distraction osteogenesis 6 weeks after end of distraction is not consistent with classical theory of the magnitude of micromotion needed for adequate stimulation of bone formation in fracture healing. The increased axial displacement did not stimulate bone healing and delayed union was observed. This one single observation does not allow for any conclusions to be drawn about the relationship of strain to fracture healing, but further and refined use of the RSA method will certainly improve our understanding of the role of axial strains in distraction osteogenesis. © 2001 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.

To assess the effects of torsional rigidity and dynamization on fracture healing in a medullary nailed rat femoral model.

In rats, bilateral closed femoral fractures were produced. On the left side, closed intramedullary nailing was done, and on the right side, the nail was inserted by an open procedure. The healing process of the fractures was evaluated at 4, 8, and 12 weeks, bone and muscle blood flows were also determined. Reaming had no acute impact on bone blood flow, while reaming and fracture halved total bone flow (P < 0.04), and reduced cortical diaphyseal flow to approximately one quarter (P < 0.01). No differences were found between the open and closed methods. At 4 weeks, the bending moment, rigidity, and fracture energy of the fractures treated by closed medullary nailing were greater than those treated by open nailing. The fracture energy was still greater at 8 weeks, while no differences were seen in bending moment and rigidity. At 12 weeks, however, there were no differences in the mechanical parameters. Bone blood flows in both the cortical diaphysis and callus area were increased at 4 and in the callus area at 8 weeks in bones treated by the open method. No differences were found at the end of the experiment. Muscle blood flow was not different in the two limbs, and was constant during the experimental period.We conclude that femoral fractures treated by closed nailing heal better in the initial phase compared with those that have been openly nailed. This difference cannot be explained by an impaired muscle or bone blood flow due to open surgery.

In male Wistar rats, a transverse osteotomy at the midshaft of the femur was made, and the acute effects on bone flow were measured before and after reaming. Flow and mechanical variables in the healing bones were measured at 4, 8, and 12 weeks following osteotomy. Osteotomy reduced total bone blood flow by about 50 percent, and cortical flow in the diaphysis by approximately 40 percent. Cortical flow was equally diminished in the middiaphysis and in the osteotomy area, and no differences between the proximal and distal diaphyseal flows were found. Reaming of the osteotomized bones did not lead to any further flow reduction. At 4 weeks, total bone flow was more than doubled; increases were found in every segment of the fractured bone, and a more than 10-fold increase in the callus area was seen. At the end of the experiment, the femurs had regained 83 percent of their normal strength, 88 percent of normal rigidity and 78 percent of normal fracture energy. At this time total bone flow was marginally increased, flows in the proximal and the distal diaph-yses were almost normalized, while a nearly 3-fold increase was still found in the callus area. Flow in the callus area gradually decreased during healing, and regression analysis demonstrated a negative correlation between callus flow and mechanical properties.

Radiography and computed tomography measurements were made of femoral neck anteversion, femoral head cartilage distribution, and the orientation of the acetabulum. The measurements were made in elderly cadaver femurs and in patients. They failed to establish any correlation between the femoral neck anteversion and the orientation of the articulating surface of the femoral head, nor between the femoral neck anteversion and the angles of the acetabulum.

The effect of training on bone strength has been investigated in rats. After 7 weeks of training, fracture strength of the tibia in vivo during muscle contraction and after resection was assessed. A group of 30 male rats 11 weeks old were randomized to exercise on a treadmill, sedentary (ordinary caging), and inactivity (right‐sided patellar tendonectomy) groups. The training group ran on a treadmill with a 10% inclination for 1 h per day. After 4 weeks the animals in all groups were anesthetized and the right lower legs loaded in three‐point ventral bending until fracture during electrically induced muscle contraction. The contralateral tibiae were tested correspondingly after resection. Ultimate bending moment, energy absorption to failure, bending stiffness, and deflection were assessed for the in vivo and the resected tibiae. The body weight gain was 37% higher in the sedentary and 57% higher in the inactive animals than in the training group (P< 0.05), indicating a physiologic effect of the training. In the dissected tibiae there were no significant group differences in any of the mechanical parameters, indicating that neither training nor inactivity changed the structural capacity of the tibiae per se. In contrast, there were significant differences between the in vivo tibiae. Ultimate bending moment was 12% higher in the training group than in the sedentary and inactive groups (P= 0.03). Energy absorption in the training group was 11 and 12% higher (not significant) than in the sedentary and inactivity groups, respectively. Bending stiffness was 7 and 17% higher in the training group compared to sedentary and inactivity groups (P= 0.018). These results indicate that muscle training protects against fracture in vivo.

The purpose of this study was to evaluate biomechanical, structural, and blood flow changes of the femoral canal in rats 12 weeks after intramedullary reaming, nailing, or occlusion. In one group, reaming alone was performed. In a second group, reaming was followed by use of a tight‐fit steel nail. In a third group, reaming was followed by use of inert silicone that totally plugged the medullary cavity. A fourth group served as the control. The acute mechanical and vascular effects caused by reaming and nailing were determined in a separate group. Reaming and nail insertion reduced blood flow in femoral bone to about one‐third. Reaming reduced bending moment by approximately 40%, whereas bending rigidity was unchanged. After 12 weeks, the cortical bone blood flow was significantly increased in both the nailed and the silicone‐plugged bones compared with the reamed and control groups. The bending moment and energy absorption in the silicone group were inferior to those of the other groups. There were no differences in either the external or internal diameter or the medullary and net bone areas. In the silicone group, both the number and the area of large pores (larger than 10 μm) significantly increased in comparison with the other groups; hence, bone porosity was increased. This increment was confined to large pores. It is concluded that medullary occlusion contributes to structural and blood flow changes in bone.

We studied the effects of short-term therapy with methylprednisolone and indomethacin on healing of intramedullary pinned osteotomies of the femur in rats. When the osteotomy was complete and healing occurred under unstable conditions with callus formation, indomethacin inhibited healing when estimated by mechanical tests of bending moment, energy expenditure before refracture, and bending rigidity 6 weeks after surgery. No inhibitory effects were seen following corticosteroid treatment. When the osteotomy was incomplete and healing occurred under stable conditions, similar tendencies were observed.Thus, short-term medication with indomethacin inhibits fracture healing. This was not the case with short-term methylprednisolone.

This paper presents a clinical review of patients operated by different procedures for disabling osteoarthritis of the carpometacarpal joint of the thumb. Fusion of the joint resulted in pain relief, and the patients achieved a stable thumb with excellent strength. Although a minor loss of thumb motion was noted, this was not considered a problem. Excision of the trapezium gave good results with respect to pain relief, but there was loss of thumb stability and strength. Implant arthroplasty with a silicone prosthesis appeared to give a painfree, stable and mobile thumb, but there was loss of power. In conclusion, arthrodesis is the method of choice if reduction of strength is to be avoided.

The effects of acute ischaemic heart failure on renal blood flow and the influence of dopamine at low dose range and high doses of insulin were examined. Acute left ventricular (LV) failure was induced in dogs by injection of 50-μm plastic microspheres into the left main coronary artery. The dogs showed signs of severely depressed LV function. Cardiac output was decreased to a significantly greater extent than renal blood flow, and while total peripheral resistance was significantly increased, there were no significant changes in renal vascular resistance. The results indicate different sympathetic discharge to the various vascular beds during acute ischaemic heart failure. Dopamine at low dose range and high doses of insulin were found to improve myocardial contractility and to reduce renal vascular resistance and increase renal blood flow.

The biomechanical effects of intramedullary reaming on the healing of femoral osteotomies were studied. In rats, transverse osteotomies at the midshaft of both femurs were made. On the left side only, reaming of the medullary cavity was performed, and the osteotomies were then stabilized by intramedullary pinning. At 15, 30, 60, and 90 days after osteotomy, the production of callus, the bending moment, and the bending rigidity were evaluated. There were no significant differences in these biomechanical parameters between the right unreamed and the left reamed femurs during the experimental period. The results indicate that reaming of the medullary cavity of diaphyseal bone does not significantly impair or improve the healing of pinned osteotomies in rats.

Femoral neck angles were determined in 44 patients with unilateral or bilateral idiopathic osteoarthritis of the hip. The mean anteversion angle was 20° ± 9° and the neck-shaft angle 131° ± 7°. In comparison with a normal material the anteversion was significantly larger in the patients (P < 0.001), but no difference was found in the neck-shaft angle. A positive correlation between the size of the anteversion and the severity of the disease was observed.It is concluded that increased anteversion of the femoral neck may contribute to the development of osteoarthritis of the hip.

A controlled clinical trial.

Infusion of the peptide secretin augments cardiac output due to vasodilating and inotropic properties. The aim of this investigation was to study how the increased cardiac output is distributed in the peripheral circulation. Before, during and after 15 min infusion of secretin 64 CU kg−1h−1flow changes in renal, carotid, femoral and the superior mesenteric arteries were measured by means of electromagnetic flowmetry in anaesthetized dogs. Cardiac output and stroke volume increased by 41 and 27, respectively, whereas the total systemic resistance fell 35. The LVdPdt increased by 35. After 5 min infusion, renal and carotid flows increased by 62 and 50, respectively, whereas the femoral flow was only slightly elevated and the superior mesenteric flow unchanged. Both the femoral and the superior mesenteric flow gradually augmented and at the end of the infusion flow was substantially elevated in all four arteries. The study demonstrated that the increased cardiac output by secretin was distributed to all the four arteries, although a preponderance of flow to the renal circulation was indicated. This flow profile may be regarded as favourable in the management of low output conditions.

In this rat study, we found tibial periosteal hyperplasia and hypertrophy, and appositional new bone formation 3 days after transient hindlimb ischemia. This response was positively correlated to the extent of muscle necrosis, which was increased either by raising the environmental temperature during ischemia or by prolonging the period of ischemia.By changing the temperature from 21 °C to 34 °C, the area periost in percent of the total tibial area was increased from 5 to 17, and by changing the duration of ischemia from 3 to 5 hours, it increased from 8 to 18.

We studied the healing of segmental and simple middiaphyseal fractures in male Wistar rats. In one group we produced two standardized partial osteotomies with an 8 mm intermediary fragment in the femoral diaphysis and in the other group a simple partial osteotomy. The osteotomies were then manually broken, retaining the periosteal and muscular attachment on the medial side. The fractures were stabilized with a 1.6 mm steel pin, and the animals were allowed free movement. After 4, 8, and 12 weeks, 8 rats in each group were killed, and callus formation, mechanical parameters and bone blood flow were evaluated.There were no differences in callus production between the simple and segmental fractures throughout the experimental period. The mechanical parameters increased in both groups, and the healing patterns were the same. No differences were found in the total bone blood flow, but the callus blood flow in the segmental fractures was lower after 8 and 12 weeks than that in the simple fractures.Our findings indicate that closed segmental fractures treated by intramedullary nailing can regain strength in the same manner as simple fractures.

In rats, bilateral closed femoral fracture was produced after intramedullary reaming to 1.6 mm on the left side and 2.0 mm on the right side. The fractures were fixed with 1.6 and 2.0 mm steel pins. Radioactive microspheres were used to determine bone blood flow at 30 min, 1 day, 3 days and 9 days after fracture. 8 rats were used to estimate normal bone blood flow, and an additional 8 rats to examine the vascular effects of fracture only.Following fracture, total bone blood flow was reduced to about 50 percent and cortical flow to about 40 percent of that in intact bones. Fracture and reaming to 1.6 mm reduced total bone flow to 40 percent and reaming to 2.0 mm reduced the total bone flow to approximately one third of normal flow. Cortical flow decreased to about one third and one quarter in the 2 groups. On Day 1, total flow was practically normalized in both groups. Cortical flow in the 1.6 mm group was about equal to that of intact bones, while it was about one third of normal flow in the 2.0-mm group, and significantly less than the 1.6-mm group. On Day 3, total bone flow was more than double that of intact bones and cortical flow 3 times greater in both groups. Flow continued to increase to Day 9 when a threefold increase in total bone blood flow and approximately a fivefold increase in cortical flow were found. On Day 9, a separate callus area was defined and flow measurement revealed a rich vascularized callus in both groups, but no differences between the groups were found.Following fracture, neither moderate nor aggressive intramedullary reaming seem to create any further impairment in bone flow. Following fracture and reaming, blood flow is rapidly restored, however, extensive reaming results in a delayed restoration of cortical bone blood flow. After 9 days, rich vascularized callus areas were found irrespective of the initial degree of reaming.

Examination of the hip joint by computed tomography was evaluated in 34 children admitted to hospital with symptoms of idiopathic increased anteversion of the femoral neck and in 6 children with congenital dislocation of the hip. Anteversion of the femoral neck and the acetabulum was determined from tomographic cross-sections, and femoral anteversion was also determined by conventional radiography. A good correlation was found between these two methods.The relationship between anteversion of the femoral neck and that of the acetabulum was calculated in the 34 patients with idiopathic increased femoral anteversion. Increased anteversion of the femoral neck was not compensated for by a corresponding reduction in the ventral orientation of the acetabulum. In many cases the adjustment of the acetabulum to the femoral head was poor.In some of the patients the degree of external rotation of the hip was greater than would be expected from the relationship between the anteversion of the femoral neck and that of the acetabulum. In these patients the lower limb is forced outwards when walking, causing the femoral head to dislocate laterally and forwards.Based on the results of this study we conclude that calculation of the anteversion, both of the femoral neck and acetabulum, should play an important part in the evaluation of candidates for derotational osteotomy of the femur. Computed tomography yields valuable information in this respect.

The development of femoral neck angles in children with idiopathic increased anteversion was investigated. The anteversion (AV) angle in 16 non-operated patients (n = 32) decreased from a mean of 45 degrees at the age of 7.3 years (median) to 31 degrees at the age of 15.7 years. The neckshaft (CCD) angle remained unchanged.A subtrochanteric derotational osteotomy was performed in 24 patients (n = 48) aged 7.7 years (median). The AV angle was corrected from 47 to 3 degrees, and the CCD angle from 134 to 124 degrees. At follow-up at the age of 16.5 years the AV and the CCD angles had increased to 14 and 135 degrees respectively. The internal rotation of the hip was increased to the same extent in the two patient groups. The degree of external rotation as well as total rotation was significantly larger in the non-operated patients compared to the patients who needed an operation.At follow-up the rotational movements of the hip and the external torsion of the leg/foot were measured and compared with the corresponding measurements for a control group of 26 healthy subjects whose median age was 16.3 years. In the non-operated patients the internal rotation was reduced at a rate corresponding to the spontaneous reduction of the femoral anteversion, while the external rotation was unchanged. In the operated patients the rotational movements were normalized, as was the anteversion of the femoral neck. No differences in external torsion of the leg/foot were found in the three groups.Based on these results we conclude that cases of idiopathic increased anteversion of the femoral neck are not corrected spontaneously as the child grows up. With a subtrochanteric derotational osteotomy slight overcorrection may be indicated, but simultaneous varus correction of the femoral neck seems to be unnecessary. The degree of external rotation of the hip determines gait symptoms in patients with increased femoral anteversion. No regular compensatory external torsion of the leg/foot develops during growth.

We examined the acute effects of increasing degree of intramedullary reaming on bone blood flow in 27 male Wistar rats by use of the microsphere method. A marginal reduction in total bone and cortical bone blood flow was seen when the femoral canal was reamed to a diameter smaller than the medullary cavity (1.5 mm). Reaming equal to the antero-posterior diameter (1.8 mm) halved total bone flow and reduced cortical blood flow by one third. Reaming equal to the transverse diameter (2.1 mm) reduced total bone flow to one third and cortical bone flow by one third.Intramedullary reaming of the tibia to 1.5 mm reduced total blood flow about 50 percent whereas cortical flow in the proximal half was unchanged. We conclude that modest intramedullary reaming has little effect on total and cortical blood flows, whereas reaming which involves destruction of the endosteal cortex reduces both total bone and cortical blood flows.

Instability was induced in transversally osteotomized rat femora by means of intramedullary nails with various degrees of interlocking. Osteotomies that were stably pinned healed with less callus than those unstably pinned; no differences were found between rotational stable and unstable pinned osteotomies. Mechanical testing revealed that osteotomies treated by rotational stability and axial telescoping healed better than stably fixed and rotational unstable osteotomies. No differences were found between osteotomies treated by rotational instability and rigidity fixed fractures. We conclude that instability favors fracture healing as compared to rigidity. However, rotational instability in addition to telescoping impairs callus formation.

Torsion of the leg was measured in 50 adults by computed tomography. The tangent to the dorsal aspect of the femoral condyles gave the proximal reference line. The distal reference line joined the centers of the medial and lateral malleoli. Tibial torsion was measured as the inclination between the dorsal tangent to the tibial condyles and the distal reference line, and torsion of the leg was measured as the inclination between the proximal and the distal reference lines. The anatomy of the dorsal aspects of the tibial condyles was more inconsistent than the anatomy of the dorsal aspects of the femoral condyles. In the females the external torsion of the leg was 38 ± 9° on the right side and 37 ± 11° on the left side. In the males the values were 41 ± 6° and 40 ± 10°, respectively.

The effects of the fentanyl fluanisone combination (Hypnorm®) and pentobarbitone sodium (Pentobarbital®) anaesthesia on blood glucose, insulin and glucagon were tested in rats in the fed and fasted state. Blood glucose was measured before and at 10, 20 and 30 min after injection of the anaesthetic agents. At 30 min the rats were sacrificed, and blood was drawn for measurement of glucagon and insulin. Pre-anaesthetic values for insulin and glucagon were established in separate groups of fasted and fed rats.In fasting rats given Hypnorm®, blood glucose and plasma insulin were unchanged while there was a non-significant increase in plasma glucagon. The fasted rats given Pentobarbital®had unchanged blood glucose and plasma insulin and a non-significant depression of glucagon.The fed rats given Hypnorm®had a significant increase in blood glucose at 10 min and nearly a doubling of glucose values at 20 and 30 min (P<0.001). Glucagon increased far less than in the fasted group, whereas insulin was doubled from preanaesthetic values (P<0.05). The fed rats given Pentobarbital®, had unchanged blood glucose, a slight nonsignificant depression of glucagon and a significant increase in insulin (P<0.01).Thus Hypnorm®induced hyperglycaemia in fed but not in fasted rats, probably because more glucose was available in the fed state. Fed animals are a modification of the standard fasted animal model, and may be preferable when exploring hyperglycaemic or other reactions to anaesthetic agents.

1. Twenty-five minute daily muscle stretching, perpendicular to the fibre direction of the adductor muscles without movement of the hip, was performed in patients with osteoarthritis of the hip. 2. Before and after treatment hip abduction was measured and muscle biopsies were taken for analysis of fibre cross-sectional areas of type 1 and type 2 fibres as well as adenosine 5′-triphosphate, creatine phosphate and glycogen contents. 3. From the results it is concluded that passive muscle stretching leads to a significant increase in hip abduction of 8.3° (P < 0.05). There was also a significant increase of type 1 and type 2 fibre cross-sectional area and of glycogen content after the treatment period (P < 0.05), but the concentrations of adenosine 5′-triphosphate and creatine phosphate did not change significantly.

The medullary cavities of both femora in 35 rats were reamed, and bone cement was injected on the left side. A partial transverse osteotomy of the midshaft of both femora was then performed. At 0, 15, 30, 60, and 90 days following operation, the bending moment and elastic stiffness of the osteotomies were evaluated. No significant differences were found between the right and left femora. It is concluded that acrylic bone cement injected into the medullary cavity does not significantly impair the healing of osteotomies in rats.

In rats, a partial, transverse osteotomy at the midshaft of both femurs was made. In two thirds of the bones, the osteotomy was manually broken and stabilized, either by a tightly fitting or by a loose intramedullary nail. The healing process of the osteotomies was evaluated at 30, 60, and 90 days after the operation. The stable osteotomies healed by direct bone union, and the unstable osteotomies healed by the formation of external callus. At 30 days, the bending moment, rigidity, and energy absorption of the stable osteotomies were significantly greater than those of the unstable osteotomies. At 60 days, however, there were no significant differences in these parameters. During the observation period, no significant differences in mechanical properties were found between the osteotomies nailed with a tightly fitting or a loose intramedullary nail. It is concluded that healing of rigidly fixated fractures is a rather slow, steady process in relation to healing of unstably fixated fractures. Different degrees of instability of intramedullary nailed fractures do not seem to be of significant importance as to the eventual recovery of mechanical properties.

Abstract: The pancreatic glands from six male Wistar rats weighing between 200 and 250 g were isolated and perfused. After 30-min equilibration and 20-min basal periods, perfusion with 0.2 mg/ml of morphine for 20 min resulted in a significant (P<0.05) increase in insulin release, with no changes in release of gucagon or somatostatin. After a recovery period of 20 min, a higher morphine concentration of 2 mg/ml was introduced for another 20-min period. With this morphine dose there were significant increases in release of insulin (P<0.05), glucagon (P<0.01) and somatostatin (P<0.05). This shows that morphine induces the release of insulin, glucagon and somatostatin from pancreas in a dose-dependent way, and that release of insulin and glucagon is not primarily affected by regulation of somatostatin levels.

In male Wistar rats, a transverse osteotomy of the midshaft of the left femur was performed. The rats were allocated to three groups: 1) one that under-went a 4-week training program 4 weeks after the osteotomy, 2) one that had a tenotomy of the left Achilles tendon to prevent weight bearing, and 3) one that had normal function and activity. Eight weeks after the osteotomy, total bone, proximal diaphyseal, callus, and muscle blood flows were measured using the microsphere technique. Initial and final body weights, bone weight, and callus production were also recorded. There were no differences in bone or muscle blood flow between the three groups. An increase in total bone and muscle blood flows was seen on the osteotomized side. In weight-bearing rats, the callus area was more vascular as compared with the diaphyseal bone. No correlation between callus mass and callus flow was found. Our results support the concept that blood supply is mandatory for fracture healing; however, other factors seem to be decisive for the rate of healing.

In one group of rats, the medullary cavity was reamed and bone cement was injected. In a control group, only reaming was performed. A closed fracture was then produced in the middle of the femur. At 40,60 and 90 days following operation the torsional moment, the elastic stiffness, the volume and the density of the callus tissue were evaluated. No differences were found between the two groups. It is concluded that acrylic bone cement in the medullary cavity does not impair the healing of non-immobilized fractures in young rats.

In 3 groups of rats, bilateral femoral fractures were produced. The fracture hematoma was removed on one side after 30 min, 2 days and 4 days in the 3 groups, respectively. The fractures were mechanically tested at 4 weeks.When the fracture hematoma was removed early, callus production, bending moment, and fracture energy were decreased. Removal of the hematoma at Day 2 or 4 impaired fracture healing even more, as both bending moment, bending rigidity and fracture energy were greatly decreased compared to the control fractures. We conclude that the fracture hematoma favors healing; removal of the hematoma after some days is more harmful to healing than when the hematoma is removed in the initial phase.

We have operated on 51 old injuries with abduction instability of the metacarpophalangeal joint of the thumb. The time from injury to operation was 8 weeks to 5 years. Ligament repair was made in 29 cases. In 22 cases arthrodesis of the joint was performed because of primary unsuccessful operation or arthrosis of the joint.

We determined the effect of a shortening/lengthening osteotomy on muscle fiber cross-sectional area in the vastus intermedius in 14 rats. The left femur was shortened 5 mm in half of the rats and elongated 5 mm in the other half. In both groups, the right femur was osteotomized and stabilized without shortening/lengthening. After 3 months, open biopsy specimens of the vastus intermedius were taken for measurements of the muscle cross-sectional area in both Type 1 and Type 2 fibers; 150 fibers were measured in each specimen. In the shortened group, the cross-section was reduced in both types of fibers. After lengthening, no differences in the fiber cross-sectional area were found.We conclude that differences in stretch and tension of the muscles are responsible for the atrophy after femoral shortening and the maintenance of the fiber cross-sectional area after lengthening.

In the years 1961–1975 we have treated thirty-one men and twenty-four women for ulnar nerve palsy at Kronprinsesse Märthas Institutt. The age ranged from sixteen to seventy-eight, the majority were in mid-adult life. Thirty-four nerves on the right arm and twenty-seven on the left were operated on with anterior transposition. This clinical material has been analysed regarding aetiology and management. The neuropathy was secondary to trauma or disease at the elbow in thirty-five cases and primary with a normal elbow in twenty-six cases. At operation it was found that the neuropathy was due to fibrous compression in 36 per cent and to hypermobility in 21 per cent. In 43 per cent there were no macroscopic reasons for neuropathy. We have re-examined fifty-two patients at an average time of seven and a half years after the operation. The results were found to be excellent in 47 per cent, good in 30 per cent and poor in 23 per cent. The results were independent of duration of symptoms before the operation and independent of the surgical findings at the operation. The results were also the same whether the nerve at the transposition was put intramuscularly or just subcutanously.

In a postmortal study we found that 1 ml. fluid injected through the triradiate cartilage into the hip joint of a newborn child was enough to cause instability. This instability persisted even after aspiration of the fluid. The findings were confirmed by ultrasonography.

Bilateral closed femoral fractures were produced in two groups of rats. Reaming was made from the trochanteric area before fracture, and the fractures were stabilized by intramedullary pinning. In one (hematoma) group, both femurs were exposed subperiosteally at the midshaft prior to fracture. At one side, the hematoma was evacuated 30 min following fracture, at the other side the hematoma was left undisturbed. In the other (periosteal) group, the femur was exposed subperiosteally at one side, while the periosteum was left intact at the other side. The healing of the fractures was evaluated at 4 weeks. In the hematoma group, no differences were found in callus production, while bending moment and bending rigidity were greater at the side where the hematoma was not removed. No differences were found in fracture energy. In the periosteal group, marginal differences were found in the callus area. Bending moment, bending rigidity and fracture energy were greater at the side where the periosteum was left intact. A comparison of all four limbs, showed that the periosteal sealing was of particular importance for rapid healing.

The effects of different degrees of function and weight bearing on the healing of femoral osteotomies were studied in rats. A transverse osteotomy of the left femur was stabilized by intramedullary pinning. The rats were allocated to three groups: (1) tenotomy of the left achilles tendon to avoid weight bearing, (2) unrestricted weight bearing, and (3) a 4-week training pro-gramme 4 weeks after the osteotomy. After 8 weeks, the rats were killed; and callus production, bending moment, bending rigidity, and fracture energy at the osteotomy site were evaluated. There were no differences in the area of external callus. The bending moment was less in the nonweightbearing rats. Bending rigidity and fracture energy were marginally less in the nonweight-bearing rats. There were no significant differences between the weight bearing and exercised rats. The results indicate that normal weight bearing stimulates bone healing, whereas activity above normal neither accelerates nor impairs this process.

Summary Surgical correction of hallux valgus deformity is often indicated. We have analyzed the results of subcapital osteotomy of the metatarsal in 112 feet. The time of observation has been from 5–12 years. The results were found to be excellent in 73.2%, good in 20.5% and poor in 6.3%. By the radiological examination it was shown that the success of corrective osteotomy depends on adequate displacement of the metatarsal head.

A direct method of ultrasonographic measurement of the anteversion angle of the femoral neck is presented. Normal values based on measurements in 30 random newborns with vertex presentation correspond well with figures from previous autopsy series. The femoral anteversion in breech presentation was found to be on average 10° greater than in vertex presentation (p<0.0001).

In this study, the association between increased femoral anteversion and external torsion of the leg was investigated by computed tomography in adults. In a control group of 15 women, the anteversion angle of the femoral neck measured 11°±9° and 12°±9° for the right and left sides, respectively. The external torsion of the leg was 40°±8° and 39°±10°, respectively. The patient group consisted of 16 women who were evaluated for clinical symptoms related to increased femoral anteversion. In this group, the femoral anteversion was 31°±7° and 33°±7° for the right and left sides, respectively, and the external torsion of the leg was 35°±10° and 33°±12°, respectively. There were no correlations between the degree of femoral anteversion and the degree of external torsion of the leg. This study indicates that in cases of increased femoral anteversion, compensatory external torsion of the leg does not develop regularly during growth.